125 research outputs found
Field Epidemiology Assessment for a Medical Evacuation Programme Related to the Crisis in Kosovo, 1999
In complex human emergency (CHE)-aid situations, the international community responds to provide assistance to reduce morbidity and mortality related to environmental and civil disruptions. The political and social situation in Kosovo, in combination with the military activity from 23 March to 09 June, 1999, created a crisis associated with mass movement of the population of Kosovo into neighbouring provinces and nations. This forced migration of people seeking protection increased demands for -water, food, shelter, and health care in the refugee areas. The United Nations High Commission for Refugees (UNHCR) estimated that 771,900 ethnic Albanians, and 30,700 Serbians, Croatians, and Montenegrins had been displaced from Kosovo during this time period, and that 439,500 of these people had arrived in Albania. Given the limited health-care resources in Albania to respond to the increasing demands for health care, a field epidemiological study was conducted by the International Organization for Migration (IOM) to assess the need for a medical evacuation program from Albania related to the crisis in Kosovo. Outcome measurements in this assessment were: 1) health-care capacity and health-care utilization rates in Albania before the crisis and by the refugees during the crisis; 2) the frequency of war-related injuries; 3) the frequency of medical evacuation; 4) nature of medical conditions of the patients being evacuated; and 5) destination for medical evacuation (internal or international) during the crisis. The results of the field assessment, which gathered health outcome data during the first eight weeks of the conflict (23 March 1999 to 25 May 1999), indicated that there was a need for a specifically designed medical evacuation programme in Albania. The study demonstrated that the implementation of a medical evacuation programme must be integrated with the national health care objectives. It also was found that the magnitude of an evacuation programme could be reduced markedly by strategic support of existing medical programmes in Albania (haemodialysis, trauma and orthopaedics, blood banking). Implementation of this strategy could permit containment of the majority of cases within Albania or to regional, health-care facilities. The results of such targeted support for specific services could result in a national programme for internal medical evacuation, with limited dependence upon the international movement of patient
Late plasma exosome microRNA-21-5p depicts magnitude of reverse ventricular remodeling after early surgical repair of primary mitral valve regurgitation
Introduction: Primary mitral valve regurgitation (MR) results from degeneration of mitral valve apparatus. Mechanisms leading to incomplete postoperative left ventricular (LV) reverse remodeling (RevâRem) despite timely and successful surgical mitral valve repair (MVR) remain unknown. Plasma exosomes (pEXOs) are smallest nanovesicles exerting early postoperative cardioprotection. We hypothesized that late plasma exosomal microRNAs (miRs) contribute to RevâRem during the late postoperative period.
Methods: Primary MR patients (n = 19; age, 45â71 years) underwent cardiac magnetic resonance imaging and blood sampling before (T0) and 6 months after (T1) MVR. The postoperative LV RevâRem was assessed in terms of a decrease in LV end-diastolic volume and patients were stratified into high (HiR-REM) and low (LoR-REM) LV RevâRem subgroups. Isolated pEXOs were quantified by nanoparticle tracking analysis. Exosomal microRNA (miR)-1, â21â5p, â133a, and â208a levels were measured by RT-qPCR. Anti-hypertrophic effects of pEXOs were tested in HL-1 cardiomyocytes cultured with angiotensin II (AngII, 1 ÎŒM for 48 h).
Results: Surgery zeroed out volume regurgitation in all patients. Although preoperative pEXOs were similar in both groups, pEXO levels increased after MVR in HiR-REM patients (+0.75-fold, p = 0.016), who showed lower cardiac mass index (â11%, p = 0.032). Postoperative exosomal miR-21-5p values of HiR-REM patients were higher than other groups (p < 0.05). In vitro, T1-pEXOs isolated from LoR-REM patients boosted the AngII-induced cardiomyocyte hypertrophy, but not postoperative exosomes of HiR-REM. This adaptive effect was counteracted by miR-21-5p inhibition.
Summary/Conclusion: High levels of miR-21-5p-enriched pEXOs during the late postoperative period depict higher LV RevâRem after MVR. miR-21-5p-enriched pEXOs may be helpful to predict and to treat incomplete LV RevâRem after successful early surgical MVR
The web of laughter: frontal and limbic projections of the anterior cingulate cortex revealed by cortico-cortical evoked potential from sites eliciting laughter
According to an evolutionist approach, laughter is a multifaceted behaviour
affecting social, emotional, motor and speech functions. Albeit previous
studies have suggested that high-frequency electrical stimulation (HF-ES)
of the pregenual anterior cingulate cortex ( pACC) may induce bursts of
laughterâsuggesting a crucial contribution of this region to the cortical con-
trol of this behaviourâthe complex nature of laughter implies that outward
connections from the pACC may reach and affect a complex network of fron-
tal and limbic regions. Here, we studied the effective connectivity of the
pACC by analysing the cortico-cortical evoked potentials elicited by
single-pulse electrical stimulation of pACC sites whose HF-ES elicited laugh-
ter in 12 patients. Once these regions were identified, we studied their
clinical response to HF-ES, to reveal the specific functional target of pACC
representation of laughter. Results reveal that the neural representation of
laughter in the pACC interacts with several frontal and limbic regions,
including cingulate, orbitofrontal, medial prefrontal and anterior insular
regionsâinvolved in interoception, emotion, social reward and motor be-
haviour. These results offer neuroscientific support to the evolutionist
approach to laughter, providing a possible mechanistic explanation of the
interplay between this behaviour and emotion regulation, speech production
and social interactions.
This article is part of the theme issue âCracking the laugh code: laughter
through the lens of biology, psychology, and neuroscienceâ
A IMPORTĂNCIA DA PRODUĂĂO DE DOCUMENTOS ACESSĂVEIS PARA SALA DE AULA
Em tempos remotos nos deparamos com uma infodemia, materiais produzidos, com imagens inseridas, com letras utilizadas sem pensar na acessibilidade do conteĂșdo para todas as pessoas e suas condiçÔes, acabam tornando o material inacessĂvel para pessoas com deficiĂȘncia ou com alguma necessidade especĂfica. Dentro das diretrizes de acessibilidade, as primeiras açÔes, depois da inserção de tecnologias Assistivas ao AVA, foram observadas que sem a produção de Materiais Educacionais AcessĂveis para Aprendizagem, recursos como descriçÔes de texto para imagens ou legendas ocultas e transcriçÔes de vĂdeos, iriam permanecer inacessĂveis para alguns alunos. AçÔes bĂĄsicas, como fornecer contraste de cor suficiente, reduzem o esforço de alunos para perceber as informaçÔes tornam o aprendizado uma experiĂȘncia mais agradĂĄvel. Desse modo, nos questionamos: como tornar o texto legĂvel e acessĂvel para todos? As respostas vieram por meio do uso da tecnologia assistiva, e foram evidenciadas sobretudo com o aumento de pessoas com deficiĂȘncia ao AVA, de forma eficiente, incluindo as pessoas com tipos variados de deficiĂȘncias. Assim tornar o texto legĂvel e acessĂvel Ă© incluir digitalmente a Todos. Entendemos que dentro das diretrizes de acessibilidade, as primeiras açÔes, depois da inserção de tecnologias Assistivas ao AVA, foram observadas que sem a produção de Materiais Educacionais AcessĂveis para Aprendizagem, os recursos como descriçÔes de texto para imagens ou legendas ocultas e transcriçÔes de vĂdeos, iriam permanecer inacessĂveis para alguns alunos. AçÔes bĂĄsicas, como fornecer contraste de cor suficiente, reduzem o esforço de alunos para perceber as informaçÔes tornam o aprendizado uma experiĂȘncia mais agradĂĄvel. Durante a elaboração e desenvolvimento desta pesquisa-ação foram levados em consideração os preceitos da resolução 510/2016 do Conselho Nacional de SaĂșde, no que tange aos aspectos Ă©ticos para a pesquisa com seres humanos. O projeto foi submetido ao ComitĂȘ de Pesquisa UNIR via Plataforma Brasil, com a aprovação pelo Certificado de Apresentação de Apreciação Ătica - CAAE no 40381020.9.0000.5300. Esta pesquisa versa sobre a importĂąncia da produção de documentos com acessibilidade. Para tanto foi criado um curso sobre produção de documentos com acessibilidade, dentro de uma pesquisa interventiva, para provocar nos profissionais da educação a revisĂŁo de suas prĂĄticas quanto a produção do material acessĂvel utilizado em suas aulas e em outras açÔes que demandem o uso de material didĂĄtico ou similares e consequentemente sua capacitação, foram desenvolvidas aulas sĂncronas, vinculadas na plataforma ava que permitam as açÔes de pertencimento e estabeleça o vĂnculo Discente e Docente para desenvolvimento de trabalhos; solicitação de autorização de gravação do minicurso para evitar a tecnofobia e trazer tranquilidade para o aluno. Evitar a infodemia no momento do minicurso. Recursos disponĂveis (apostila com tutorial). Concomitante a prĂĄtica de identificação e elaboração de material e documentos acessĂveis discuteâse as questĂ”es que demandam ou sĂŁo resultantes da acessibilidade atitudinal. Entendemos que com a produção de documentos acessĂveis, automaticamente, tornando-os legĂveis pelas ferramentas de apoio, os conteĂșdos podem lidos e usados por todos e as pessoas com deficiĂȘncia podem ler o conteĂșdo e trabalhar com os arquivos. Essa Ă© a perspectiva inclusiva do trabalho
Endovascular Treatment of Degenerative Aneurysms Involving Only the Descending Thoracic Aorta : Systematic Review and Meta-analysis
Purpose: To determine the efficacy of thoracic endovascular aortic repair (TEVAR) for degenerative aneurysm involving only the descending thoracic aorta (DTAA). Methods: An English-language literature review was performed through PubMed, Scopus, and Google Scholar to identify any study evaluating the outcomes of TEVAR for DTAA. The main endpoints of this analysis were all-cause 30-day and late postoperative mortality. Secondary outcome measures were procedure success, vascular access complications, paraplegia, stroke, early endoleaks during the index hospitalization, aneurysm-related death, reinterventions, and conversion to open repair. To control for the anticipated heterogeneity among small observational studies, absolute values and means were pooled using random effects models; the results are expressed as pooled proportions, means, or risk ratio (RR) with 95% confidence intervals (CIs). Results: Eleven studies reporting on 673 patients (mean age 72.6 years, mean aneurysm diameter 62.9 cm) with DTAA were selected for the analysis. Technical success was reported in 91.0% of patients, and vascular access complications requiring repair were encountered in 9.7% of cases. Pooled overall 30-day, 1-year, 2-year, and 3-year survival rates were 96.0%, 80.3%, 77.3%, and 74.0%, respectively. Five studies compared the results of TEVAR after elective (n=151) and urgent/emergent procedure (n=77); the latter was a predictor of 30-day mortality (17.1% vs 1.8%, RR 3.83, 95% CI 1.18 to 12.40, p=0.025). Paraplegia occurred in 3.2% of patients and was permanent in 1.4% of patients. The stroke rate was 2.7%. Early type I endoleak was observed in 7.3%, type II endoleak in 2.0%, and type III in 1.2% of patients. The mean follow-up of 9 studies was 22.3 months. At 3 years, freedom from reintervention was 90.3%. Death secondary to aneurysm rupture and/or fistula was reported in 3.2% of patients. Conclusion: Current results indicate that TEVAR for DTAA can be performed with rather high technical success, low postoperative morbidity, and good 3-year survival.Peer reviewe
The Makey Makey Inclusive Tangible Interface and its Educational Perspectives
Traditional human-computer interaction using a keyboard and mouse attached to a computer has been modified with the emergence of technologies that incorporate resources into clothing, furniture and everyday objects. These technologies open up new opportunities for designers to create innovative forms of interaction based on gestures, body movements or physical manipulation of real objects. One such innovation is the tangible interface, which allows computer users to interact with digital systems through the manipulation of
physical objects. The Makey Makey interface, for example, is a printed circuit with a microcontroller that allows everyday objects to be used as computer keys. This paper presents a literature review of reported experiences with Makey Makey, the objective being to explore new educational and inclusive perspectives. For that, the main researches related to Makey Makey from 2012. The methodology used is characterized by the Goal-Question-Metric (GQM) protocol and included 14 articles in total. The results showed that the circuit can be used in several contexts, with important reports from the medical field with patients with cerebral palsy from the perspective of inclusion and
motivational activities with the elderly. In addition, it was possible to verify that the contexts are varied, including entertainment, fun, games and a multitude of possibilities in the pedagogical area, especially if we consider their insertion in Early Childhood Education, integrating music and stimulating inventiveness.Ministerio de Ciencia, InnovaciĂłn y Universidades PID2019-105455GB-C31Junta de AndalucĂa P20_0064
Genetic differentiation and phylogeography of Mediterranean-North Eastern Atlantic blue shark (Prionace glauca, L. 1758) using mitochondrial DNA: Panmixia or complex stock structure?
Background
The blue shark (Prionace glauca, Linnaeus 1758) is one of the most abundant epipelagic shark inhabiting all the oceans except the poles, including the Mediterranean Sea, but its genetic structure has not been confirmed at basin and interoceanic distances. Past tagging programs in the Atlantic Ocean failed to find evidence of migration of blue sharks between the Mediterranean and the adjacent Atlantic, despite the extreme vagility of the species. Although the high rate of by-catch in the Mediterranean basin, to date no genetic study on Mediterranean blue shark was carried out, which constitutes a significant knowledge gap, considering that this population is classified as âCritically Endangeredâ, unlike its open-ocean counterpart.
Methods
Blue shark phylogeography and demography in the Mediterranean Sea and North-Eastern Atlantic Ocean were inferred using two mitochondrial genes (Cytb and control region) amplified from 207 and 170 individuals respectively, collected from six localities across the Mediterranean and two from the North-Eastern Atlantic.
Results
Although no obvious pattern of geographical differentiation was apparent from the haplotype network, Ίst analyses indicated significant genetic structure among four geographical groups. Demographic analyses suggest that these populations have experienced a constant population expansion in the last 0.4â0.1 million of years.
Discussion
The weak, but significant, differences in Mediterranean and adjacent North-eastern Atlantic blue sharks revealed a complex phylogeographic structure, which appears to reject the assumption of panmixia across the study area, but also supports a certain degree of population connectivity across the Strait of Gibraltar, despite the lack of evidence of migratory movements observed by tagging data. Analyses of spatial genetic structure in relation to sex-ratio and size could indicate some level of sex/stage biased migratory behaviour
Effectiveness of a phone-based nurse monitoring assessment and intervention for chemotherapy-related toxicity: A randomized multicenter trial
PurposeAnticancer treatment-related toxicities can impact morbidity and mortality, hamper the administration of treatment, worsen the quality of life and increase the burden on the healthcare system. Therefore, their prompt identification is crucial. NICSO (Italian Network for Supportive Care in Cancer) conducted a nationwide randomized trial to evaluate the role of a planned, weekly phone-based nurse monitoring intervention to prevent and treat chemotherapy, targeted therapy- and immunotherapy-related toxicities. Here, we report the results from the chemotherapy arm. MethodsThis was a nationwide, randomized, open-label trial conducted among 29 Italian centers (NCT04726020) involving adult patients with breast, colon, or lung cancer and a life expectancy >= 6 months receiving adjuvant chemotherapy. Patients received either a weekly nurse monitoring phone call and an educational leaflet reporting practical advice about prevention and treatment of toxicities (experimental group) or the educational leaflet only (control group). ResultsThe addition of a nurse monitoring intervention may help reduce time spent with severe toxicities (grade >= 3), particularly those less frequently reported in clinical practice, such as fatigue. When considering grade 1-2 AEs, times with mild/moderate diarrhea, mucositis, fatigue and pain were shorter in the experimental arm. Time spent without AEs was significantly longer in the experimental arms for all the toxicities. The requirement for special medical attention was comparable between groups. ConclusionThis study suggests the need for implementing a better system of toxicity assessment and management for patients treated with adjuvant chemotherapy to promote effective preventive and/or therapeutic intervention against these events
Short- versus long-term dual antiplatelet therapy after drug-eluting stent implantation: An individual patient data pairwise and network meta-analysis
Background Randomized controlled trials comparing short- (â€6 months) with long-term (â„1 year) dual antiplatelet therapy (DAPT) after drug-eluting stent(s) (DES) placement have been insufficiently powered to detect significant differences in the risk of major adverse cardiac events (MACE). Objectives This study sought to compare clinical outcomes between short- (â€6 months) and long-term (1 year) DAPT and among 3 months, 6 months, and 1 year of DAPT post-DES placement by performing an individual patient data pairwise and network meta-analysis. Methods Randomized controlled trials comparing DAPT durations after DES placement were searched through the MEDLINE, EMBASE, and Cochrane databases and in international meeting proceedings. The primary study outcome was 1-year risk of MACE (cardiac death, myocardial infarction, or definite/probable stent thrombosis). Results Four trials including 8,180 randomized patients were identified. At 1-year follow-up, short-term DAPT was associated with similar rates of MACE (hazard ratio [HR]: 1.11; 95% confidence interval [CI]: 0.86 to 1.43; p = 0.44), but significantly lower rates of bleeding (HR: 0.66; 95% CI: 0.46 to 0.94; p = 0.03) versus prolonged DAPT. Comparable results were apparent in the landmark period between DAPT discontinuation and 1-year follow-up (for MACE: HR: 1.20; 95% CI: 0.77 to 1.89; p = 0.42) (for bleeding: HR: 0.44; 95% CI: 0.21 to 0.91; p = 0.03). There were no significant differences in 1-year rates of MACE among 3-month versus 1-year DAPT, 6-month versus 1-year DAPT, or 3-month versus 6-month DAPT. Conclusions Compared with prolonged DAPT, short-term DAPT is associated with similar rates of MACE but lower rates of bleeding after DES placement
Language lateralization mapping (reversibly) masked by non-dominant focal epilepsy: a case report
Language lateralization in patients with focal epilepsy frequently diverges from the left-lateralized pattern that prevails in healthy right-handed people, but the mechanistic explanations are still a matter of debate. Here, we debate the complex interaction between focal epilepsy, language lateralization, and functional neuroimaging techniques by introducing the case of a right-handed patient with unaware focal seizures preceded by aphasia, in whom video-EEG and PET examination suggested the presence of focal cortical dysplasia in the right superior temporal gyrus, despite a normal structural MRI. The functional MRI for language was inconclusive, and the neuropsychological evaluation showed mild deficits in language functions. A bilateral stereo-EEG was proposed confirming the right superior temporal gyrus origin of seizures, revealing how ictal aphasia emerged only once seizures propagated to the left superior temporal gyrus and confirming, by cortical mapping, the left lateralization of the posterior language region. Stereo-EEG-guided radiofrequency thermocoagulations of the (right) focal cortical dysplasia not only reduced seizure frequency but led to the normalization of the neuropsychological assessment and the ârestoringâ of a classical left-lateralized functional MRI pattern of language. This representative case demonstrates that epileptiform activity in the superior temporal gyrus can interfere with the functioning of the contralateral homologous cortex and its associated network. In the case of presurgical evaluation in patients with epilepsy, this interference effect must be carefully taken into consideration. The multimodal language lateralization assessment reported for this patient further suggests the sensitivity of different explorations to this interference effect. Finally, the neuropsychological and functional MRI changes after thermocoagulations provide unique cues on the network pathophysiology of focal cortical dysplasia and the role of diverse techniques in indexing language lateralization in complex scenarios
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